NYMC Faculty Publications
Impact of Pre-ictal Antiplatelet Therapy Use in Aneurysmal Subarachnoid Hemorrhage
Author Type(s)
Faculty
DOI
10.1016/j.clineuro.2021.107022
Journal Title
Clinical Neurology and Neurosurgery
First Page
107022
Last Page
107022
Document Type
Article
Publication Date
12-2021
Department
Neurosurgery
Second Department
Neurology
Abstract
OBJECTIVE: There is limited evidence on the use of antiplatelet therapy (APT) to reduce the risk and morbidity of cerebral aneurysmal rupture. This analysis retrospectively assessed APT use in patients presenting to our institution with aneurysmal subarachnoid hemorrhage (aSAH).
METHODS: We evaluated the records of 186 patients over 7 years of retrospective data from our tertiary care center and an existing database of patients with aSAH. A total of 18 cases with patients on APT and 168 patients not on APT (controls) were identified. Primary outcomes measured were clinical grade (Hunt and Hess score), radiographic grade (Fisher score), and presence of delayed cerebral ischemia (DCI). Secondary outcomes were modified Rankin score at discharge and at 3 months. DCI from cerebral vasospasm was defined as the occurrence of focal neurological impairment or a decrease in at least 2 points on the Glasgow Coma Scale. Logistic regression models were generated.
RESULTS: We found that APT use did not appear to lead to statistically significant differences in initial presentation, including Hunt-Hess score and Fisher grade (2.91 vs 3.06, p = 0.66, and 3.23 vs 3.22, p = 0.96 respectively). In addition, APT use was not associated with increased rates of delayed cerebral ischemia (DCI) (OR 0.27 p = 0.12). Our analysis showed that increased Hunt Hess score and the presence of DCI are both associated with increased mRS at 90 days (OR 2.32 p < 0.001; OR 2.91 p = 0.002).
CONCLUSION: The patients in this retrospective observational study did not demonstrate worse outcomes from their aSAH despite APT therapy. Larger prospective studies should be performed to see if this relationship holds and if decreased rates of DCI can be observed.
Recommended Citation
Al-Mufti, F., Ogulnick, J., Feldstein, E., Damodara, N., Bravo, M., Alshammari, H., Dominguez, J., Cooper, J., Huang, K. T., Marikunte, S., Ali, S., Patel, V., Khandelwal, P., Mayer, S. A., Amuluru, K., & Gandhi, C. D. (2021). Impact of Pre-ictal Antiplatelet Therapy Use in Aneurysmal Subarachnoid Hemorrhage. Clinical Neurology and Neurosurgery, 211, 107022-107022. https://doi.org/10.1016/j.clineuro.2021.107022
